Author: James Fuccione

Dual Eligible Services Demo RFR Now Available

The state’s Executive Office of Health and Human Services (EOHHS) has released the Request for Responses relative to the demonstration project to integrate care for dually eligible individuals.

The RFR is a solicitation for potential Integrated Care Organizations, or ICO’s, that will manage the integration of services and payment for dual eligibles aged 21-64. The Home Care Alliance is holding a special event for all agencies interested in this initiative. Please see the event in our Calendar section titled “Building Partnerships with Managed Care Plans for Dual Eligible Care” where special guest speakers will educate attendees on the demonstration and how agencies can play a key role. Potential ICO’s have also been invited for discussion and networking.

For those interested in viewing the  solicitation and corresponding materials, the instructions are below:

1)  In your browser, enter the URL for the Commonwealth’s procurement web page: www.comm-pass.com.

2)  Near the bottom of the page, click on the hyperlink that reads: “Search for Solicitations.”

3)  When the Search page comes up, scroll down to the section that says “Search by Specific Criteria” and in the document number box, enter the following: 12CBEHSDUALSICORFR.

4)  The Search result will appear as a hyperlink at the top of the new page. It should read: “There is 1 solicitation(s) found that match your search criteria.”  Click on this sentence and it will take you to the Comm-PASS listing for this solicitation.

5)  Click on “view” (the eyeglasses on the right) and you will get the summary page for the Request for Responses for Integrated Care Organizations.

6)   Click on the blue folder-type tab called “Specifications” and you will see the RFR documents and appendices that have been posted for this topic. In addition, the required forms that Respondents to the RFR will need to provide are available under the “Forms and Terms” tab.  To view the documents, click on the eyeglasses to the right of the title of each document,  .

The documents will also be posted shortly on our duals demonstration website, www.mass.gov/masshealth/duals, under “Information for Organizations Interested in Serving as ICOs.”

Responses to the RFR will be due to MassHealth by 4:00 PM (EDT), July 30, 2012.

Return to www.thinkhomecare.org.

State Budget Advocacy Needed on Telehealth

The FY13 state budget conference committee that will meld the House and Senate budget proposals are in negotiations and HCA needs your help in advocating so that we can achieve MassHealth reimbursement of telehealth services and adequate funding in the state home care programs.  (According to Mass Home Care, there were 935 elders on the Enhanced Community Options program waiting list as of May, 2012.)

Members and advocates can do their part by calling or emailing the members of the conference committee and asking them to:

  1. Support Senate budget amendment #692 which would direct Masshealth to reimburse for telehealth services
  2. Support the House funding proposal over the Senate’s for Enhanced Community Options Program (ECOP), line-item 9110-1500.  The House budget proposal gives the ECOP program $1.327 million more than the Senate.
  3. Support House funding proposal over the Senate’s for Elder Home Care Purchased Services, line-item 9110-1630.  The House budget gives almost $500,000 more dollars to this account which funds the Basic Elder Home Care program.

Here are the names, email addresses and phone numbers of the conference committee:

The telehealth amendment language, data, and talking points are all available on a fact sheet prepared by the Alliance.  Please contact these legislators today, even if they do not represent your area.  Please urge your legislators to do all he/she can to support this funding. In addition, when you speak to your Senator’s office, be sure to thank the Senate for adding this critical funding to their FY13 budget proposal.

If you or the legislators you speak with have any questions, contact James Fuccione at HCA.

Return to www.thinkhomecare.org.

HCA Achieves Gains for Home Care in House Health Care Bill

With the passage of a major health care payment reform bill by both the state’s senate and house of representatives, the Alliance will advocate for the successes gained in each version as the proposals advance.

In the recently passed House version, the Alliance was successful in advocating that home health and hospice services are included in the definition of “health care services” under an Accountable Care Organization able to accept global payments.

Other provisions achieved, include:

  • An amendment to strengthen the relationship between Patient-Centered Medical Homes and federally-certified home care agencies by ensuring that those agencies are available through the medical home to provide “after-hours” availability to home care patients.
  • An amendment that  improves the state’s “fair share contribution” calculation for determining an employer’s percentage of insured workers. With this amendment, any employee insured through a spouse, parent, Medicare/Medicaid, a veterans’ plan or disability plan would NOT be counted towards the employer’s test by the state and thus reduces the chance the employer would have to pay the “fair share contribution” penalty ($295 per employee).
  • An amendment adding “a community-based organization or group of community-based organizations” to those entities available to receive funding from the Prevention and Wellness Trust Fund.
  • An amendment ensuring that community-based behavioral health providers are included in the state’s health information technology planning process and that providers who serve high proportions of public payer clients will be given priority in receiving funding through a “health information technology revolving loan fund.”

The Alliance will continue to advocate for these provisions, in addition to those gained in the Senate, which can be seen in our blog post on the Senate’s passage of their payment reform bill.

Return to www.thinkhomecare.org.

 

Mass Nurses Association Misrepresents Alliance Proposal

In an effort to advance a major policy priority, the Home Care Alliance took the language of the “nurse delegation” bill – formally known as S.2242, An Act Relative to Home Health Aides – and had it filed as an amendment to the health care payment reform bill proposed in the state’s House of Representatives.

State Representative Kay Khan, a psychiatric nurse, agreed to file the amendment on behalf of the Alliance, which would allow (not mandate) nurses in the home care setting only to delegate certain medication administration tasks to certified home health aides. As the amendment was being considered by Rep. Khan’s colleagues in the House, the Massachusetts Nurses Association circulated this document to state representatives.

The document completely misrepresents the intent and substance of the language proposed by HCA. The inaccurate assertions, along with misguided advocacy of the MNA based on those inaccuracies,  led to the amendment being withdrawn.

The Home Care Alliance has met with the MNA to reeducate their leaders on the actual intent of the proposal and voice deep concern that their document was saturated with erroneous comments.

The Nurse Delegation bill itself remains in a Senate committee tasked with scheduling the proposal for a vote before the full Senate.

Return to www.thinkhomecare.org.

 

Senate Passes $32.4 Billion Budget with Telehealth Reimbursement

Building off the success of getting a telehealth amendment in the Senate’s Health Care Payment Reform bill, the Home Care Alliance earned a victory with the Senate also passing a telehealth amendment during their budget deliberations.

The amendment establishes MassHealth reimbursement for telehealth services provided by home health agencies through regulations that have yet to be determined. The next step for the initiative, though, is to get through a conference committee where the House and Senate meet to hammer out the differences in their separate budget proposals. That final product is then sent to the Governor for his approval.

The Alliance will have new advocacy messages available on the Legislative Action Center once the legislature’s budget conference committee is named.

The Alliance’s other priorities pertaining to Certificate of Need, home health nursing rates past 60 days of care, and relative to pediatric home care were not passed, although the certificate of need issue is seeing increased interest. This and the passage of telehealth owe credit to the hundreds of emails sent out by HCA members and advocates through the Legislative Action Center.

The other major item that the Senate approved was the Human Service Salary Reserve worth $20 million. This account to provide a slight increase in pay for 31,500 human service workers in the state was not approved by the House and will be a huge bargaining chip in conference committee negotiations. If passed, the increase in pay would amount to about $12 per week, per worker.

Other amendments of note that passed the Senate budget include a special commission to study causes, prevention and treatment strategies pertaining to Chronic Obstructive Pulmonary Disorder (COPD). This would present an opportunity for home care to promote their chronic disease management programs and telehealth services. Also passed was an amendment that would create an advisory committee on long-term services and supports. If passed in the state’s final budget, home care agencies would have a chance to be on the committee or at least to submit data and recommendations.

Finally, other rejected amendments from the Senate included items from the state’s Home Care Program from the Executive Office of Elder Affairs that funds the ASAP programs. Specifically, the amendments for Home Care Purchased Services, Enhanced Community Options, and Case Management were all denied.

Return to www.thinkhomecare.org.

Advocacy Alert: Contact Your State Senator to Support Home Care in the FY13 Budget

The Massachusetts senate is set to debate what will become their version of the state’s FY13 budget this week. Several senators have filed amendments to the budget proposal on behalf of the Home Care Alliance that reflect industry priorities and agency members and advocates are encouraged to contact their senator to urge their support.

Below are prepared emails that can be sent simply by clicking the issue of concern, filling out the contact information form, reviewing the message and clicking “send.” Fact sheets are available by clicking the “read about this issue” link below each heading.

Support Certificate of Need for Home Care in FY13 Budget
Support Telehealth in the FY13 Budget
Please Support Home Health Rates in the FY13 Budget
Support Pediatric Home Care in the FY13 Budget

Senate offices can also be contacted by phone and a listing of each senator is available here. For those who are unsure who represents them in the senate, go to wheredoivotema.com and type in your address.

When calling, ask that they support the following amendments (mention the amendment number, name, and who sponsored the amendment).

# 559               Certificate of Need                                          Offered by Sen. Michael Moore

  • Massachusetts is one of five states without either licensure or a CON requirement for home care and the proper oversight will ensure a level of quality assurance for patients without adding cost to the Commonwealth.

# 692               Telehealth Reimbursement                              Offered by Sen. Richard Moore

  • Instructing MassHealth to reimburse home health care providers for telehealth remote patient monitoring would save costs by not having to pay for unnecessary nursing visits, is used in many other states, and the service is reimbursed by Medicare.

# 554               Home Health Rates                                        Offered by Sen. Michael Moore

  • The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This amendment would restore that rate and would strengthen agencies that keep at-risk MassHealth clients out of costlier settings.

# 682               Pediatric Home Care Services             Offered by Sen. Thomas Kennedy

  • This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements over independent nurses who have no such requirements.

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Guest Post: Fraud and Abuse Tied to MD Face-to-Face Encounters

The following is a guest blog post on fraud and abuse issues by Robert W. Markette, Jr., CHC, Of Counsel for
Benesch Friedlander Coplan & Aronoff LLP. Mr. Markette’s primary areas of practice are health law and litigation and his wide range of health care clients includes home health, hospice and private duty providers.

Mr. Markette is also responsible for assisting the Home Care Alliance with its “Keeping it Legal in Home Care” resources on patient choice.

To view the entire article, click the link after the introduction:

As home health and hospice care continue to become more and more competitive and reimbursement continues to decline, referral sources are discovering new ways to leverage this for their own benefit. Two new examples include physicians requesting “administrative fees” to complete face to face paperwork and referral sources seeking “donations” from providers to defray the cost of capital equipment and other improvements. Providers need to understand the risks in these arrangements in order to avoid entering into arrangements that place them in violation of the Anti-Kickback Statute and/or the Stark Law.

The entire article from Mr. Markette is available here.

 

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HCA Succeeds with Amendments to Senate Health Care Payment Reform Bill

The Massachusetts Senate spent the past week debating their landmark health care payment reform proposal, which included 265 amendments that were filed after Senate leadership released the bill to all Senators and the general public.

The Home Care Alliance worked to have several amendments filed and advocated for other amendments that were seen as beneficial.

The Alliance saw victories in the adoption of the following amendments:

  • Amendment #43, which instructs insurers to cover telemedicine.
  • Amendment #13, which allows employers to count a spouse or parent’s insurance coverage to qualify their employee under the state’s “fair share contribution” regulation.
  • Amendment # 223, which adds community-based behavioral providers to the e-Health Institute’s spectrum of care.
  • Amendment # 121, which requires hospitals, nursing homes, and assisted living facilities to provide appropriate patients with information regarding the availability of palliative care and end-of-life options.
  • An amendment installing a representative of a certified home care agency on an e-Health Commission.

The focus on health care payment reform will move to the House although the timing on that debate and process has not yet been formally announced. Stay tuned to our UPDATE newsletter and the HCA blog for the latest information. If members or advocates have any questions related to payment reform, please contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

State Budget Update: Senate Ways and Means Releases Proposal for Debate

The Senate Committee on Ways and Means released their recommendations for the state’s fiscal year 2013 budget. The full 40-member Senate will introduce amendments by the end of this week and will debate the proposal beginning next week. Here are some of the highlights concerning home care:

MassHealth Line Items:

  • The MassHealth Managed Care account (line item 4000-0500) dips $6 million below what the House approved in their version at $4.158 billion.
  • The MassHealth Senior Care account (line item 4000-0600) comes in at $7,230,000 below what the House proposed at $2.756 billion.
  • The MassHealth Fee-for-Service Payments account (4000-0700) saw a bigger slash from the House version of $26.8 million, coming in at $1.927 billion.

Elder Affairs/State Home Care Program Line Items:

  • Elder Enhanced Home Care Services (9110-1500) saw a decrease from the House version of $1,327,853 set at $46.4 million.
  • The Home Care Purchased Services account (9110-1630) was also set below the House’s budget version by $497,837 at a total of $97.2 million.
  • The Elder Nutrition account (9110-1900) does not match the House’s version, but still restores a cut to that program made by the Governor. The Senate Ways and Means version is set at $6.325 million.

In summary, the Senate Ways and Means budget proposal chips down all MassHealth and Elder Affairs line items. These amounts may be restored at least partially after the full Senate concludes their debate and also following when the Senate and House name members to a conference committee to work out differences between the two budgets.

The Home Care Alliance will continue to advocate for a MassHealth nursing rate increase, Certificate of Need, Telehealth, and strengthening pediatric home care services.

Check back to the blog to find out how you can support HCA’s budget priorities.

Return to www.thinkhomecare.org.

House Releases Health Care Payment Reform Legislation

Nurses Hall in the State House was crowded with attendees eager to hear highlights of a long awaited bill on health care payment reform.

House Speaker Robert DeLeo and the Health Care Financing Committee’s House Chair Representative Steve Walsh announced their proposal that will be followed soon by a Senate version that will transition the state away from fee-for-service payments.

During his speech, Chairman Walsh said that the bill would save the state $160 billion over fifteen years and would bring full health IT interoperability to Massachusetts within five years. Accountable Care Organizations are not mandated, but are among options that providers can shift into from the current fee-for-service model. Chairman Walsh, in fact, mentioned four payment options that providers can choose: bundled, episodic, global and the patient centered medical home. He added that if there is an innovative model that does not include fee for service payments, a provider or provider group is welcome to bring that to the table as a proposal. Chairman Walsh also mentioned home health during his State House speech in reference to workforce development and although home care was not specifically mentioned in that section of the bill, it appears there would be an opportunity in the form of pilot projects and future policy recommendations.

At a quick glance, here are some other notable sections concerning home care:

  • Section 60: the Home Care Alliance is mentioned by name as having one representative on a special committee that will make recommendations on behavioral health services (page 67).
  • Section 105: Insurance coverage of physician assistant care is established “for purposes of health maintenance, diagnosis and treatment,” which includes “home care setting” as a covered benefit (page 128).
  • Section 109: The bill creates a new medical malpractice section that puts “home health agency” in the definition of a facility (page 133).

News outlets are beginning to release articles on the bill, including this story on Boston.com.

The Home Care Alliance will provide updates and more information as the bill continues to be examined.

Return to www.thinkhomecare.org.